27 Feb Alcohol-Containing Antiseptics During Facial Surgery Can Cause Corneal Damage

MedicalResearch.com Interview with:

Dr. Yu-Chih Hou

Yu-Chih Hou, MD
Department of Ophthalmology
National Taiwan University Hospital
Taipei, Taiwan

MedicalResearch: What is the background for this study?

Dr. Yu-Chih Hou: We have encountered 3 patients with right eye pain and corneal edema after left orofacial surgery under general anesthesia since December 6. 2010. The first patient underwent a left tongue tumor excision by an ENT doctor. Postoperative day one, corneal epithelial defect and edema with mild anterior chamber reaction were noted in the right eye. Because his presentation was different from corneal abrasion which was the most common eye injury after general anesthesia, we suspected this ocular complication could be due to toxic reaction to antiseptic. Although corneal edema decreased, corneal endothelial cell density decreased and cataract developed later in the first patient. Two months later, the second patient had a similar toxic keratopathy but with severe corneal edema in his right eye after wide tumor excision of left lower gingival cancer by dentist surgeons. We found the antiseptic they used contained alcohol. We recommended not to use alcohol-containing antiseptics in oral surgery. Unfortunately, more severe toxic keratopathy occurred in the third patient after a left nasal tumor excision by other ENT doctor one year later. Because these severe ocular complications may occur again, it raised us to do detail study and we found all antiseptics they used contained alcohol. We hope to prevent occurrence of this toxic keratopathy in nonocular surgery by reporting our findings to other clinicians.

MedicalResearch: What are the main findings?

Dr. Yu-Chih Hou: They presented with eye pain, red eye, blurred vision in their dependent eye right after orofacial operation. Slit-lamp biomicroscopic examination showed corneal epithelial defect, corneal edema, Descemet membrane folds, and mild anterior chamber reaction. Although topical corticosteroids were given to reduce inflammation and damage, corneal edema, opacity, stromal neovascularization, limbal insufficiency, and cataract formation could develop later. Some of them may need cataract surgery, endothelial keratoplasty, or penetrating keratoplasty to restore vision.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Yu-Chih Hou: Clinicians need to know alcohol-containing antiseptic agents used during orofacial surgery may cause toxic keratopathy. The lateral or prone position is associated with an increased risk of ocular injury. The lateral tilt position may increase the chance of chemicals accumulating in the eyelid medial commissure, resulting in a greater risk of damage to the nasal and inferior cornea of the dependent eye. Extra attention should be paid to the eyelid medial commissure of the dependent eye when patients undergo orofacial surgery in the lateral tilt position. We suggest using alcohol-free antiseptic agents may reduce the risk of corneal injury in head and neck surgery. Patients need to know the risks of ocular injury in nonocular surgery, especially in head and neck surgery. Patients are aware of the possible symptoms and signs of ocular injury after operation. Early treatment with intensive corticosteroids may reduce the severity of toxic keratopathy.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Yu-Chih Hou: We recommend to do animal study to compare the corneal toxicity between alcohol-containing antiseptics and alcohol-free antiseptics with different concentration of alcohol or antiseptics and the exposure duration, which may answer what antiseptics are safe. But we need to concern the possible reduction of the disinfection effect. We may take a long-term study in clinic to compare the rate of ocular complications and wound infection before and after using alcohol-free antiseptics in head and neck surgery.

MedicalResearch: Is there anything else you would like to add?

Dr. Yu-Chih Hou: Clinicians need to know anesthesia inhibits the protective Bell phenomenon and reduces tear production, and longer surgical procedures cause greater ocular vulnerability such as corneal abrasion. Eye protection should be made by careful closure of eyelid with tape to prevent the lagophthalmos during anesthesia and reduce the risks of antiseptics leaking into eyelid fissures, especially in head and neck surgery. Clinicians also need to know alcohol and chlorhexidine are toxic to cornea. Long-time exposure with alcohol-containing antiseptics may cause permanent corneal damage including endothelial cells loss and corneal opacity. Using 10% povidone iodine solutions without alcohol or other detergents and carefully performing facial disinfection with proper eye protection may reduce the risk of toxic keratopathy. Extra attention should be paid to the eyelid medial commissure of the dependent eye when patients undergo orofacial surgery in the lateral tilt position.

Citation:

Dr. Yu-Chih Hou (2016). Alcohol-Containing Antiseptics During Facial Surgery Can Cause Corneal Damage MedicalResearch.com

Last Updated on February 27, 2016 by Marie Benz MD FAAD